Emphysematous pyelonephritis: Difference between revisions
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==Background== | ==Background== | ||
*Rare gas-forming infection nearly always occurring in | [[File:Blausen 0592 KidneyAnatomy 01.png|thumb|Renal anatomy.]] | ||
** | *Rare gas-forming infection nearly always occurring in patients with [[DM]] and obstruction | ||
**Patients appear toxic and [[septic]]; nephrectomy may be required | |||
{{UTI types}} | |||
==Clinical Features<ref> Tang HJ, et al. Clinical characteristics of emphysematous pyelonephritis. J Microbiol Immunol Infect. 2001 Jun. 34(2):125-30. </ref>== | ==Clinical Features<ref> Tang HJ, et al. Clinical characteristics of emphysematous pyelonephritis. J Microbiol Immunol Infect. 2001 Jun. 34(2):125-30. </ref>== | ||
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*[[Nausea/vomiting]] | *[[Nausea/vomiting]] | ||
*[[Dyspnea]] | *[[Dyspnea]] | ||
*Renal dysfunction | *[[AKI|Renal dysfunction]] | ||
*[[Altered mental status]] | *[[Altered mental status]] | ||
*[[Shock]] | *[[Shock]] | ||
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{{Dysuria DDX}} | {{Dysuria DDX}} | ||
== | ==Evaluation== | ||
===Labs=== | ===Labs=== | ||
*CBC with high WBC, low platelets | *CBC with [[leukocytosis|high WBC]], [[thrombocytopenia|low platelets]] | ||
* | *[[Urinalysis]] with urine culture | ||
*Creatinine | *Creatinine | ||
*Blood culture | *Blood culture | ||
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===Imaging=== | ===Imaging=== | ||
*CT is definitive | *CT is definitive | ||
*Staging<ref>Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med. 2000 Mar 27. 160(6):797-805.</ref>: | |||
**Class 1 - gas confined to collecting system | |||
**Class 2 - gas confined to renal parenchyma alone | |||
**Class 3A - perinephric extension of gas or abscess | |||
**Class 3B - extension of gas beyond Gerota fascia | |||
**Class 4 - bilateral or EPN in solitary kidney | |||
==Management== | ==Management== | ||
*IVF | *[[IVF]] | ||
*Antibiotics | *Antibiotics | ||
**IV ampicillin, gentamicin, metronidazole | **IV [[ampicillin]], [[gentamicin]], [[metronidazole]] | ||
**Vancomycin in place of ampicillin for | **[[Vancomycin]] in place of [[ampicillin]] for penicillin allergy | ||
==Disposition== | ==Disposition<ref>Shetty S et al. Emphysematous Pyelonephritis Treatment & Management. eMedicine. Apr 11, 2014. http://emedicine.medscape.com/article/457306-treatment#showall.</ref>== | ||
*Urological | *Poor prognostic risk factors: | ||
**Creatinine > 1.4mg/dL | |||
**Platelets < 60k | |||
**Altered mental status | |||
**Shock | |||
*Urological consult for percutaneous drainage, stent placement, or nephrectomy (classes 3 and 4 with 2 or more prognostic risk factors) | |||
*Presence of obstructive stone requires even more urgent surgical intervention | |||
*Mortality rates between ~20-40% | |||
==See Also== | ==See Also== | ||
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==External Links== | ==External Links== | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Renal]] | ||
[[Category: | [[Category:Urology]] | ||
[[Category:ID]] | |||
Revision as of 10:42, 2 May 2020
Background
- Rare gas-forming infection nearly always occurring in patients with DM and obstruction
- Patients appear toxic and septic; nephrectomy may be required
Genitourinary infection
"UTI" frequently refers specifically to acute cystitis, but may also be used as a general term for all urinary infections; use location-specific diagnosis.
- Renal/perirenal
- Ureteral
- Infected urolithiasis
- Bladder
- Acute cystitis ("UTI")
- Chronic cystitis
- Urethra/periurethra
Clinical Features[1]
- Fever
- Abdominal pain or Flank pain
- crepitus over the flank may be present in severe cases
- Nausea/vomiting
- Dyspnea
- Renal dysfunction
- Altered mental status
- Shock
- Thrombocytopenia
Differential Diagnosis
Dysuria
- Genitourinary infection
- Acute cystitis ("UTI")
- Pyelonephritis
- Urethritis
- Chronic cystitis
- Infected nephrolithiasis
- Prostatitis
- Epididymitis
- Renal abscess/perinephric abscess
- Emphysematous pyelonephritis
- Nephrolithiasis
- Urethral issue
- Urethritis
- Urolithiasis
- Urethral foreign body
- Urethral diverticulum
- Allergic reaction (contact dermatitis)
- Chemical irritation
- Urethral stricture or obstruction
- Trauma to vagina, urethra, or bladder
- Gynecologic
- Vaginitis/cervicitis
- PID
- Genital herpes
- Pelvic organ prolapse
- Fistula
- Cystocele
- Other
- Diverticulitis
- Interstitial cystitis
- Behavioral symptom without detectable pathology
Evaluation
Labs
- CBC with high WBC, low platelets
- Urinalysis with urine culture
- Creatinine
- Blood culture
Imaging
- CT is definitive
- Staging[2]:
- Class 1 - gas confined to collecting system
- Class 2 - gas confined to renal parenchyma alone
- Class 3A - perinephric extension of gas or abscess
- Class 3B - extension of gas beyond Gerota fascia
- Class 4 - bilateral or EPN in solitary kidney
Management
- IVF
- Antibiotics
- IV ampicillin, gentamicin, metronidazole
- Vancomycin in place of ampicillin for penicillin allergy
Disposition[3]
- Poor prognostic risk factors:
- Creatinine > 1.4mg/dL
- Platelets < 60k
- Altered mental status
- Shock
- Urological consult for percutaneous drainage, stent placement, or nephrectomy (classes 3 and 4 with 2 or more prognostic risk factors)
- Presence of obstructive stone requires even more urgent surgical intervention
- Mortality rates between ~20-40%
See Also
External Links
References
- ↑ Tang HJ, et al. Clinical characteristics of emphysematous pyelonephritis. J Microbiol Immunol Infect. 2001 Jun. 34(2):125-30.
- ↑ Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med. 2000 Mar 27. 160(6):797-805.
- ↑ Shetty S et al. Emphysematous Pyelonephritis Treatment & Management. eMedicine. Apr 11, 2014. http://emedicine.medscape.com/article/457306-treatment#showall.